Externality: What Deaneries want

1
ExternalityWhat Deaneries want

• Dr Chris Callander
• Head of Wales School of Anaesthesia

2
What deaneries want

• Personal view
• Feedback from UK Anaesthetic Heads of Schools and
  RAs
• Feedback from cross-section of other specialty
  schools
• Facts and perceptions

3
Externality focus

• Urgent requirement
• Process and outcomes
• Importance of real-time trainee and patient
  experiences
• Appropriate and pragmatic
• Incorporate strengths of different externality
  systems, avoid obsession with weaknesses
• Eliminate tribalism

4
Referenced sources

• Gold Guide 2nd edition June 2008
• PMETB Quality Framework Impact assessment.
  October 2008
• PMETB Quality Framework Operational Guide
  January 2008 onwards
• PMETB Quality Framework. December 2007
• JACSTAG January 2007

5
Externality what

• ARCP guidance
• External review at least 10 of ARCP outcomes and
  any recommendations from the panel about concerns
  over progress 1
• The process is not an assessment of the trainee
  in and of itself but it is an assessment of the
  documented and submitted evidence that is
  presented by the trainee. 1
• .the trainee should not normally attend the
  panel. 1

6
Externality what

• ARCP issues
• Face to face meeting essential
• Insight into spectrum of trainees
• excellent lt gt poorly performing
• Cross-section review of 10 of ARCPs ? 10 of
  ARCP time
• Almost all UK ARCPs will be held within the same
  two month period overload

7
Externality what

• Appeal panel guidance
• The appeal panel should include a
  College/Faculty representative from an adjacent
  region 1
• Appeal panel issues
• Usually short notice need efficient and rapid
  confirmation of appropriate external
  representative

8
Externality what

• Visit guidance
• PMETB considered medical Royal College visits too
  burdensome, time and labour intensive 2
• Carrying out visits at the level of the Deanery
  .. ensures that verification occurs at the right
  level of accountability and PMETB are able to
  focus on key risks. 2
• The process of visiting provides validation, in
  checking that what is said on paper is what
  happens on the ground 2

9
Externality what

• Visit evidence base
• To reduce administrative burdens, PMETB accepts
  and endorses the principle of risk-based
  regulation 3
• The principle of reporting to PMETB will be by
  exception 3
• Exception reporting means that describing routine
  management activities is unnecessary and
  inappropriate 3

10
Externality what

• Visit issues
• Risk-based regulation and exception reporting
  approach perceived as reactive not proactive
• Exception reporting may lead to assumption that
  average satisfactory
• Perception that generic approach stifles
  specialty specific issues

11
Externality who

• College
• there must be external advice on all the
  processes of delivery, assessment and evaluation
  of specialty training. PMETB would expect that
  such specialist advice will normally come from
  the Medical Royal Colleges, colleges and
  faculties 4

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Externality who

• College
• Specialty specific (/- other specialty 2 )
• Efficient coordination by College
• Transparent, two-way relationship
• Consistent UK-wide approach
• Inter college consensus
• Appreciation of regional / devolved health
  structures
• Constructive feedback with dialogue

13
Externality who

• College representative
• No adjacency
• No reciprocal arrangements
• Appraisal process for role
• Up to date seniority / retired?
• Deanery role elsewhere?
• Head of school RA

14
Externality who

• College role
• National overview of issues and trends
• Advice
• Host heads of schools forum
• address specialty specific issues
• Host External representatives forum

15
Externality assessment

• Purpose of PMETB visits to deaneries
• Focus on the Deanerys quality management systems
  against set PMETB standards and requirements
• Focus on the relationship the Deanery has with
  local education /training providers (quality
  control)
• Focus on the Deanerys relationships with
  College/Faculties to deliver training and support
  to trainees 3

16
Externality when

• Close working with specialties through the
  colleges 3
• PMETB places responsibility for quality
  management at the deanery level, in conjunction
  with college/faculties 3
• it is only through working together that
  deaneries, and colleges and faculties, with local
  education providers, can deliver specialty
  training to the standards required 4

17
Externality when

• For QM, deaneries in conjunction with colleges
  and faculties may need to have a form of local
  visiting with the goal of improving the education
  and training opportunities. 4
• helpful to the local education providers
• enable local problem solving
• dissemination of notable practice at specialty
  level
• All such visits will be targeted and
  proportionate to the concerns identified prior to
  the visit 5
• But.....

18
Externality when

• Need to ensure real-time best practice
• Assessment of normality
• Proactive approach
• Day to day reassurance 4

19
Externality when

• Externality may be misleading
• Explicit internal role of colleges in quality
  framework should be acknowledged and assured 2,3,4

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Externality local education providers

• deaneries should consider external review by
  others....... for example, through the engagement
  of employers 3

21
Externality local education providers

• Current, partial activity of external specialty
  representatives dependant on goodwill of
  employers
• NACT documentation
• DoH service targets no training targets
• Limited financial and time resources
• Full externality programme undeliverable by
  deaneries and colleges alone

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Externality conclusion

• Urgent need for comprehensive and consistent
  externality process
• Colleges
• work together for UK wide standard approach
• Deaneries
• acknowledge and embrace unique role of Colleges
  and explore a more proactive approach
• Departments of Health
• work with LEPs to professionalise externality